CARE HOMES FOR OLDER PEOPLE
The Manor House The Manor House 61 Manor Road Medomsley Consett Durham DH8 6QW Lead Inspector
Gavin Purdon Unannounced Inspection 10th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Manor House Address The Manor House 61 Manor Road Medomsley Consett Durham DH8 6QW 01207 560099 01207 560099 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Aimgo Limited Care Home 36 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (21) of places The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25 April 2005 Brief Description of the Service: The Manor House is a care home registered to provide care and accommodation for a total of 36 older people. This home includes a unit, The Margaret Suite, which provides care and accommodation for 15 older people with dementia. There is an emphasis on integrating the service users with dementia into the main part of the home. The Manor House is owned by a private company, Aimgo Limited, which has its address in Consett, County Durham. This is the only care home operated by this company. The home is located in Manor Road which is the main road through Medomsley in North West County Durham, and is convenient for the limited local amenities of the village. The home was opened in 1990 and consists of a large, extended, and adapted two storey building. All bedrooms are in single use. There is a passenger lift to the first floor. The home has extensive and pleasant gardens with fine views over the local countryside. The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced. It was conducted by one inspector, and lasted seven and one half hours. The inspection involved discussion with staff, discussion with residents, an examination of selected care and personnel records, medication arrangements, residents’ finances as well as a check on domestic maintainance standards. The inspector also looked at what progress had been made on areas identified as needing improvement at the time of the last inspection. The general picture was one of improvements, including those that had been achieved, those that were underway, and those that were planned. What the service does well:
Positive features of the home that contribute to achieving good outcomes for residents include,the numbers of care staff on duty at The Manor House, how those staff are organized into care teams, how those staff are led, how those staff approach their work, and the standard of training achieved by staff at The Manor House. Residents spoke very highly of staff and appreciated their warmth, their caring and flexible approach to providing personal care and the way they treat each resident as an individual. “ I like to be as independent as I can, and do what I can for myself. The staff know that, but they are always there if you want them.” “ The girls here are very good, they really look after you. I think a lot of them.” “ The staff are very good. You couldn’t say any other.” Residents also singled out the very pleasant grounds of the home and the quality of the food as being particularly praiseworthy. “ The grounds are nice. I like to watch the birds, We get squirrels, magpies, pigeons, all sorts.” “ They make lovely broth with real oxtails, in the old way, not stuff out of a tin. Very good sweets, banana trifles and rhubarb and custard.” “ You eat alright here. You have choice. You can get extra. They do a nice old fashioned casserole.” The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed on this occasion. EVIDENCE: The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents benefit from an individual plan of care based on detailed assessments of health, personal care, and social care needs. These care plans make the needs and preferences of residents easier for staff and others to understand and easier for staff to provide care in a way that is safe, consistent and comfortable for residents. Residents benefit from easy access to the local community health care services they might need to use from time to time. Residents assessed as capable of administering their own medication, can do so, with support from the senior staff of the home, which is in keeping with the aim of maintaining independence and self care skills. Residents are treated with respect and their entitlement to privacy is upheld by the home, which acknowledges the need to promote and protect the rights of its residents. EVIDENCE: The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 10 The care plans seen by the inspector were well organized, easy to read, and contained important basic information. Senior Staff of the home told the inspector that recently care plans had been very helpful for new junior staff in understanding the needs and preferences of individual residents. It was noted during this inspection that the monthly schedule of care plan reviews had not been maintained and that there was no evidence found of residents, relatives, or other persons being involved in the ongoing development and maintenance of care plans. Senior staff of the home explained to the inspector through discussing individual cases how good working relationships with local healthcare practices and specialist healthcare workers helped give residents a standard of health care that was accessible, flexible, and helpful. The inspector checked the storage and records of medication administered to some of the residents spoken to on the day of the inspection. Medication was found to be securely kept, well organized, and accurately recorded. Residents told the inspector, “The girls here are good, they really look after you, I think a lot of them.” “The staff are very good. You couldn’t say any other.” “I like to be as independent as I can, and do what I can for myself. The staff know that, but they are always there when I want them. I see to some of my own medication. I’ve done it all my life. I keep a record and know exactly what’s what.” The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15. Residents benefit from living in a home that can adjust the care it provides to suit individuals with different needs and preferences. The home encourages residents to keep in touch with relatives and friends and supports residents to maintain links and relationships with other people living outside the home if that is what residents want to do. Residents own wishes are important to the home, and it does work hard to support choice and independence, but the balance between the need to ensure safety and support independence does cause practical problems that have to be sensitively managed. The home recognizes that satisfaction with the kind of food provided keeps residents healthy and happy and the home works hard to meet those needs. The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 12 EVIDENCE: The inspector spoke to various residents with different levels of need and different interests and preferences who were happy with what The Manor House has to offer them. 4 different Residents told the inspector, 1.“ I came here, I liked what I saw. The people were nice. The place was clean. The food was good. My family comes in. They like it. I go out with them.” 2. “There’s plenty of good things. I’m happy. I like the ball games and the singing. I get my visitors and I go out.” 3.“I like to be quiet, and things here suit me. The grounds are nice. I like to watch the birds. We get squirrels, magpies, pigeons, all sorts.” 4. “I’m not out much, I have good days and bad. There’s one or two here you can have a conversation with. I like my own room. I have it arranged to suit myself. There’s a good view. I see pheasants and partridges all the time. I’m content. Residents who spoke to the inspector did talk about how they had choice and control over their everyday lives, but the discussion did raise an issue about the difficulty of balancing choice and independence against the need to ensure a resident’s safety. Residents told the inspector, “The food’s good here. I like toast and marmalade and I get it. They make a lovely broth with real oxtails, in the old way, not stuff out of a tin. Very good sweets, banana trifles and rhubarb and custard.” And, “You eat alright here. You have choice. You can get extra. They do a nice old fashioned casserole.” The inspection took place over a lunchtime and it was noticed how individual support was on hand where needed, and seating arranged to make the meal as pleasant and comfortable as possible for individual residents with different needs. The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17. The home is committed to protecting its residents, and intends to develop its practice in this area further, which can only be of further benefit to its most vulnerable residents. EVIDENCE: The inspector saw general advocacy leaflets available in the home and was told that the home has occasionally worked with advocates acting on behalf of residents in the past. The home in the process of arranging specific and ongoing advocacy support for those residents without relatives or representatives. The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 In the main, residents benefit from a safe, well kept home, that is a pleasant, clean, and hygienic place to live. There are good general standards, but some environmental matters require attention. This attention is either planned or presently underway. EVIDENCE: The home has recently completed a programme of external decoration and repair and some internal redecoration to lounge areas. A new hairdressing room has been provided for the convenience and enjoyment of residents. Work is underway to improve a bathroom and make its use easier. Repair to a small amount of wheelchair contact damage on some lower walls surfaces in corridors is planned, and some general refurbishment to corridor areas is already underway.
The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 15 Clear fire safety signs and instructions were seen, as were records of fire equipment checks. Fire training and practice has taken place, but evidence was not available that all staff working at the home for the last 12 months have attended at least 2 fire drills. Generally the home is free from offensive odours. The inspector saw evidence that where these occur action is being taken to reduce and remove them. The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 28. The home is working hard and quite successfully to ensure residents benefit from a staff group that is large enough and has the skills to meet the needs of residents. The home has made a very determined effort to boost the training levels of staff and ensure that residents are cared for by a staff group that put their good care skills and understanding of good care principles into everyday practice. EVIDENCE: The inspector saw much evidence of good hands on face to face care given to residents by staff. The good rapport between staff and residents was very noticeable and when asked residents thought that staff were one of the good things about the home. The home is working hard to build up 2 teams to care for its 20 residents in need of general care due to old age, and its 15 residents suffering from dementia. The home operates with 1 acting director/manager and 2 assistant managers who support care staff teams totalling 4 to 5 members throughout the waking day, not including members of the management team. 3 carers are on duty throughout the night. Care staff are supported by a strong domestic and catering team.
The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 17 The level of care staff who are NVQ 2 holders or above has risen from 50 to 85 . Staff spoken to by the inspector believed staff training and staff deployment and numbers are having a positive and improving influence on the care of residents. The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 37, & 38. The home seeks to operate in the best interests of its residents, but needs to build on its present level of consultation with residents, relatives and others, regarding the quality of care provided and their satisfaction with and opinion of that care. The home is aware of its need to safeguard residents’ finances and has arrangements in place for doing so. Generally the home maintains a good standard of record keeping, and is aware that policies and procedures need to be available, understood and followed in order to ensure safe and consistent care for residents. Some inconsistencies in the content of staff records were noted. The home ensures that the wellbeing of residents and staff is supported by training, safe working practices, risk assessments and maintenance schedules. The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 19 EVIDENCE: Staff and residents confirmed that the home does listen to what residents have to say and does have a good relationship and communication with resident’s and resident’s relatives. Any compliments or criticisms received are recorded and responded to. The home does not approach this on a systematic basis that feeds into the individual care plan review and overall review of the home’s quality of service. The home has indicated that it does intend to do so and is working on the development of methods for doing so. The inspector checked records of money kept by the home for 2 residents, and these were found to be in order. The inspector checked staff and resident records. Generally these were well kept, although some minor improvements were required to some staff records. The records seen of health safety and maintenance activities undertaken by the home show a good standard of working practices. Named staff are responsible for undertaking and recording health and safety checks on an ongoing basis. The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 3 18 x 2 x x x x x x 2 STAFFING Standard No Score 27 4 28 4 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 3 3 2 3 The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No. 2 have been rephrased to acknowledge progress made. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23 Requirement Work presently underway and planned for bathroom and corridor refurbishment and redecoration must be completed. The fire authority must be consulted on the number of fire drills to be held annually in the home, and on requirements relating to individual staff attendance. Present work to reduce the very limited occurrence of unpleasant odours must be completed. The home must build on its present level of consultation with residents, relatives and others, regarding the quality of care provided and their satisfaction with and opinion of that care. Care staff files must include a photo that can be used for identification purposes. Timescale for action 10/01/06 2 OP33 24 10/01/06 3 OP37 17 10/01/06 The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The monthly schedule of care plan reviews should be maintained and, where possible, residents, relatives, or other such persons, should be involved in the ongoing development and maintenance of care plans. The balance between respecting a resident’s own wishes and ensuring their safety can create restrictions. Where this is the case, no matter how minor, the restriction should be consulted on, well assessed, well recorded, and well understood, its necessity reviewed and the least restrictive option adopted as a means of ensuring good practice. The home should continue the process of arranging specific and ongoing advocacy support for those residents without relatives or representatives. 2 OP14 3 OP17 The Manor House DS0000007513.V258760.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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